They say if you don’t study your history you are sure to repeat it. I have not been able to get that saying out of my head for the last few years. It started when I read the more than one-thousand- pages that are the ACA. [Affordable Care Act]

I cannot fault President Obama for knowing that drastic changes needed to be made in our healthcare insurance industry. However, I am concerned about the changes that continue to be made to our actual healthcare industry. After reading the ACA I looked at my husband and said, “This sounds like the VA. It sounds like bureaucrats will be deciding who gets what when it comes to medical care, not doctors.”

In 1963, President John F. Kennedy believed that the mentally ill should be taken care of in their homes with assistance from the government. He was motivated by the mental illness of his own younger sister who was institutionalized. Critics say it was more likely the matter of the hundreds of looming lawsuit judgments against the government due to abuse, neglect, rapes and murders in our nation’s mental institutions and the lack of federal funds to pay those judgments that motivated him.

His administration first decided that people needed to have more humanized opinions of people with mental-health disorders. They urged church, school and scout leaders to begin visiting our nation’s asylums. As a young girl scout I visited the Byberry State Hospital in Northeast Philadelphia to sing Christmas Carols for the patients. I still shudder when I remember that field trip.

The plan was to create group homes in neighborhoods. A staff of caregivers would take care of the needs of the patients. Mental health professionals and state officials would monitor the group homes. It was a good plan but unfortunately it didn’t work. The doors to the asylums were literally sprung open and the patients were released into the communities in masses. They were given twenty-five dollars, an outfit and an appointment to be accessed at a community mental health clinic many of which at the time, were not yet operational. Most of those patients wandered the streets of our neighborhoods never showing up for their appointments. Several released Byberry patients were found dead on the hospital grounds. They died of exposure.

I believe those human beings that were tortured within the walls of Byberry and every other asylum in this country deserved love, compassion at the most up to date treatment and care. Why couldn’t we make those hospitals safe for them? Why did the administration think if they could not effectively monitor what went on in the confines of a state hospital that they were going to be able to monitor what happened with these patients in the communities? Why do so many people believe that in order to protect the rights of one person and putting that person’s safety as well as the safety of entire communities at risk is okay?

The problem with our nation’s asylums was corrupt politics and a complete lack of leadership and accountability by the management and the staff. The problems began as soon as the facilities were opened back in Ben Franklin’s days. Occasionally newspapers would shine a light on the atrocities, action would be taken and the guilty would be fired. Once the media attention died down the staff member was quietly rehired and the horrors continued.

Whether we agree with the way President Kennedy opened those doors and let the mentally ill out of those state institutions, without a solid plan for after care or not we must agree that the conversation about the care and treatment of our mentally ill and intellectually challenged was started by him.

President Kennedy’s sister never left the institution.

The problems in our VA Medical System are just as systemic, probably even worse than they were in those asylums. People are dying. I fear we are headed towards just opening the doors and releasing our veterans into the already overwhelmed community health centers and the closing of our VA Medical Centers. It sounds like a great idea and a quick fix until we look back and see how opening the doors of those asylums in the nineteen-sixties created the homeless and mental health crisis we are still not dealing with today.

Removing General Shinseki as the leader of the VA Administration was overdue but it will not fix anything. Shinseki is without a doubt a good man. Sadly he is not a good leader. Leaders need to be committed to quality, accountability and results. They need to create strategies and see that their teams are responsibly implementing those strategies. The teams working in our VA medical system are implementing a complete lack of respect and disregard for our country’s heroes. They are there to collect a decent paycheck and government benefits. Nothing else is demanded of them.

When you take a manager like, Shinseki who already has no leadership skills and replace him with his own assistant who also has no leadership skills and then further complicate matters more with employee unions that will completely cripple any attempt he might make at requiring correctable action and accountability from employees chances are it will be business as usual again in no time. Add to that those narcissistic, stagnant politicians on ALL sides offering endless, useless investigations that do nothing but rob taxpayers and fatten their own wallets.

The problem that needs to be ‘fixed’ is the union ‘leader’ problem we have in this country. While unions were started for valid reasons they did exactly what they were supposed to do. We now have government employee protection agencies and laws to protect our workers from abuse, discrimination, unsafe conditions and more. Unions are a waste of hard working employee’s money and because most of them are hanging on by a thread the leaders are becoming desperate and looking for ways to ‘money grab.’

I fear we are about to repeat some very bad history here.

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My family is no stranger to the VA Health Center. My husband is a disabled Vietnam War era veteran.

We have had some good experiences at VA Medical Centers. We have met some committed and caring employees. We have also had our share of waiting, life threatening misdiagnoses and degrading treatment by V.A. staff members. I wrote about this experience (just one of many bad experiences.) a little over a year ago.

Doreen, to me, this is a thoughtful and well-written post. I don’t think you are off base at all. I have doctors as patients who are talking a lot about the frustration of the ACA and how it is changing the way they do medicine. I am seeing now how it is changing my own practice. As far as the history of mental health treatment in this country, the degradation and indignity have been sickening. And the solutions have been irrational, as you so aptly point out. I don’t know who could come forward to address it. It would be a massive organizational effort of some kind.

This post needs to be forward all the way to the top! My son works with special needs adults and the blind eyes are turned both ways. Toward the care of the inmates. And the care of the workers. The situation is a powder keg!

Truth: I can even think about most things this administration has done without turning into a raging bull, so I don’t. I step back, relax and try to believe we’ll either end up in reform or revolution sometime soon. That’s what history teaches me. =)

As Director of Social Service in a long term care facility I had some (but minimal) exposure to one facet of how the VA worked. It wasn’t a good experience. But I do think that a side issue is “painting with too broad a brush”. I think we need to look at the facilities within any system and see which ones work and why and which ones don’t and why. Just throwing out one set of guidelines for another doesn’t seem to be an approach that historically works.

As someone who worked with VA hospitals and civilian hospitals, it is the culture that needs change in the VA. There has to be a blending of military and civilian procedures and accountabilities with the patient’s care being the primary objective.